Surgical Procedures Can Be Safely Performed in Low-Resource Settings

A new study shows that surgery can be safely performed in areas with minimal resources and little or no sophisticated technology, and even in areas of violent conflict such as Southern Sudan.

Researchers at Médecins Sans Frontières (MSF; Geneva, Switzerland) conducted a retrospective cohort study that assessed 19,643 surgical procedures completed between 2001 and 2008 to determine operative mortality in surgical programs from resource-limited settings. The procedure were performed by staffers and others involved in MSF programs in Burundi, Central African Republic, Chad, Democratic Republic of the Congo, Haiti, Indonesia, Ivory Coast, Mali, Niger, Pakistan, Sierra Leone, Somalia, and southern Sudan. The main and only outcome measure was operative mortality.

The results showed that 8,329 (42%) of the procedures were emergent; 7,933 (40%) were for obstetric-related pathology procedures and 2,767 (14%) were trauma related. All the procedures occurred with at least some professional surgical help in settings equipped with anesthetics, antibiotics, blood banks, clean water, electricity, operating rooms, painkillers, post-op and postanesthesia care, or sterilization units. In all, the researchers found that operative mortality was just 0.2%, or 31 deaths, and was associated with MSF programs in conflict settings, procedures performed under emergency conditions, abdominal surgical procedures, hysterectomy, and American Society of Anesthesiologists (ASA) classifications of 3 to 5. The study was published early online on August 16, 2010, in Archives of Surgery.

"The operations were also, to some extent, self-selecting, as the site needed to have both the requisite expertise and equipment on hand to undertake the procedure,” concluded lead author Kathryn Chu, M.D., of Johns Hopkins Medical Institutions (Baltimore, MD, USA) and MSF, and colleagues. "Thus, the surgeries in the assessment don't accurately reflect the burden of surgical disease for our catchment populations. We believe that the unmet burden of surgical disease in these communities is large.”

A commentary piece published in the same issue by researchers at the State University of New York (NY, USA) claims that just 4% of the world's 320 million operations each year are performed in poor countries, despite the fact that those countries are the ones most likely to need surgical care. This means that only 5% of actual needed surgery is performed in these countries, and as a result, rates of maternal mortality are high, minor surgical pathologies become lethal, and treatable trauma progresses to death.

Related Links:
Medecins Sans Frontieres
www.suny.edu